Senate File 130 - Introduced SENATE FILE 130 BY PETERSEN , BISIGNANO , BLAKE , WINCKLER , CELSI , DONAHUE , DOTZLER , TOWNSEND , WAHLS , BENNETT , and WEINER A BILL FOR An Act relating to health insurance coverage for infertility. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 1312XS (4) 91 nls/ko
S.F. 130 Section 1. NEW SECTION . 514C.37 Infertility coverage. 1 1. As used in this section, unless the context otherwise 2 requires: 3 a. ASRM means the American society for reproductive 4 medicine or its successor organization. 5 b. Covered person means a policyholder, subscriber, or 6 other person participating in a policy, contract, or plan that 7 provides for third-party payment or prepayment of health or 8 medical expenses. 9 c. Diagnosis of and treatment for infertility means 10 the procedures and medications recommended by a health care 11 professional that are consistent with established, published, 12 or approved medical practices or professional guidelines from 13 the American college of obstetricians and gynecologists or its 14 successor organization, or ASRM, for diagnosing and treating 15 infertility. 16 d. (1) Failure to impregnate or conceive means any of the 17 following: 18 (a) For a woman under the age of thirty-five, the failure 19 to establish a clinical pregnancy after twelve months of 20 regular, unprotected sexual intercourse or therapeutic donor 21 insemination. 22 (b) For a woman thirty-five years of age or older, the 23 failure to establish a clinical pregnancy after six months of 24 regular, unprotected sexual intercourse or therapeutic donor 25 insemination. 26 (2) Conception resulting in a miscarriage does not restart 27 the twelve-month or six-month time period required to qualify 28 as having infertility. 29 e. Health care professional means the same as defined in 30 section 514J.102. 31 f. Infertility means a disease or condition characterized 32 by any of the following: 33 (1) The failure to impregnate or conceive. 34 (2) A persons inability to reproduce either as an 35 -1- LSB 1312XS (4) 91 nls/ko 1/ 4
S.F. 130 individual or with the persons partner. 1 (3) A health care professionals diagnosis based on a 2 covered persons medical, sexual, and reproductive history, 3 age, physical findings, or diagnostic testing. 4 g. Standard fertility preservation services means 5 procedures and services consistent with established medical 6 practices or professional guidelines published by ASRM or 7 the American society of clinical oncology or its successor 8 organization for a person who has a medical condition or is 9 expected to undergo medication therapy, surgery, radiation, 10 chemotherapy, or other medical treatment that is recognized 11 by health care professionals to cause a risk of fertility 12 impairment. 13 2. a. Notwithstanding the uniformity of treatment 14 requirements of section 514C.6, a policy, contract, or plan 15 providing for third-party payment or prepayment of health or 16 medical expenses shall provide coverage for a covered person 17 for the diagnosis of and treatment for infertility, and 18 standard fertility preservation services. 19 b. The coverage required by this subsection shall include 20 up to three completed oocyte retrievals with unlimited embryo 21 transfers in accordance with the guidelines of the ASRM, 22 using single embryo transfer if recommended and medically 23 appropriate. 24 c. The coverage required under this subsection for fertility 25 medications shall not be less favorable than coverage offered 26 for any other prescription medications under the policy, 27 contract, or plan. 28 d. Except as otherwise provided in this section, 29 deductibles, copayments, coinsurance, benefit maximums, 30 waiting periods, or other limitations on coverage for a covered 31 person for the diagnosis of and treatment for infertility, 32 and standard fertility preservation services, shall not be 33 less favorable than the deductibles, copayments, coinsurance, 34 benefit maximums, waiting periods, or other limitations imposed 35 -2- LSB 1312XS (4) 91 nls/ko 2/ 4
S.F. 130 on any other benefit for services covered under the policy, 1 contract, or plan. 2 3. A religious employer may request, and a policy, contract, 3 or plan providing for third-party payment or prepayment of 4 health or medical expenses shall grant, an exclusion from 5 the coverage required under this section if the required 6 coverage conflicts with the religious employers bona fide 7 religious beliefs and practices. A religious employer granted 8 an exclusion under this subsection shall provide its employees 9 timely notice of the exclusion from the policy, contract, 10 or plan providing for third-party payment or prepayment of 11 health or medical expenses the religious employer offers its 12 employees. 13 4. a. This section applies to the following classes of 14 third-party payment provider contracts, policies, or plans 15 delivered, issued for delivery, continued, or renewed in this 16 state on or after July 1, 2025: 17 (1) Individual or group accident and sickness insurance 18 providing coverage on an expense-incurred basis. 19 (2) An individual or group hospital or medical service 20 contract issued pursuant to chapter 509, 514, or 514A. 21 (3) An individual or group health maintenance organization 22 contract regulated under chapter 514B. 23 (4) A plan established for public employees pursuant to 24 chapter 509A. 25 b. This section shall not apply to accident-only, specified 26 disease, short-term hospital or medical, hospital confinement 27 indemnity, credit, dental, vision, Medicare supplement, 28 long-term care, basic hospital and medical-surgical expense 29 coverage as defined by the commissioner of insurance, 30 disability income insurance coverage, coverage issued as a 31 supplement to liability insurance, workers compensation or 32 similar insurance, or automobile medical payment insurance. 33 5. The commissioner of insurance may adopt rules pursuant to 34 chapter 17A to administer this section. 35 -3- LSB 1312XS (4) 91 nls/ko 3/ 4
S.F. 130 EXPLANATION 1 The inclusion of this explanation does not constitute agreement with 2 the explanations substance by the members of the general assembly. 3 This bill relates to health insurance coverage for the 4 diagnosis of and treatment for infertility, and standard 5 fertility preservation services (preservation services). 6 The bill requires a policy, contract, or plan (plan) 7 providing for third-party payment or prepayment of health or 8 medical expenses to provide coverage for the diagnosis of and 9 treatment for infertility, and for preservation services. 10 Diagnosis of and treatment for infertility, infertility, 11 and standard fertility preservation services are defined in 12 the bill. Required coverage includes up to three completed 13 oocyte retrievals with unlimited embryo transfers, using single 14 embryo transfer if recommended and medically appropriate. 15 Coverage of fertility medications shall not be less 16 favorable than coverage for any other prescription medications 17 under the plan. Deductibles, copayments, coinsurance, benefit 18 maximums, waiting periods, or other limitations on coverage for 19 the diagnosis of and treatment for infertility and preservation 20 services shall not be any less favorable than those imposed 21 on benefits for services covered under the plan that are not 22 related to infertility. 23 The bill provides an exception for a religious employer to 24 request an exclusion from the required coverage and requires 25 the religious employer to provide notice to employees of the 26 exclusion. 27 The bill applies to third-party payment provider contracts, 28 policies, or plans delivered, issued for delivery, continued, 29 or renewed in this state on or after July 1, 2025, by the 30 third-party payment providers enumerated in the bill. The bill 31 specifies the types of specialized health-related insurance not 32 subject to the bill. 33 The commissioner of insurance may adopt rules to administer 34 the bill. 35 -4- LSB 1312XS (4) 91 nls/ko 4/ 4